journal article
LitStream Collection
Home
Strife, Janet L.; Kun, Larry E.; Becker, Gary J.; Dunnick, N. Reed; Bosma, Jennifer; Hattery, Robert R.
doi: 10.1148/radiol.2432061954pmid: 17456861
Malone, Dermot E.; Staunton, Marie
doi: 10.1148/radiol.2432060009pmid: 17456864
So far, this series has described and illustrated the first four steps of the five-step evidence-based practice (EBP) process that was originally designed and taught by the medical epidemiologists of McMaster University (Hamilton, Ontario, Canada) and the National Health Service Centre for Evidence-Based Medicine (University of Oxford, Oxford, England). This article in the series first briefly considers the fifth step (evaluate). A more detailed consideration of caveats, common questions, and challenges relevant to EBP in radiology then follows. These are issues that merit some thought by those beginning or continuing work in EBP.
Baker, Mark E.; Einstein, David M.; Herts, Brian R.; Remer, Erick M.; Motta-Ramirez, Gaspar Alberto; Ehrenwald, Eduardo; Rice, Thomas W.; Richter, Joel E.
doi: 10.1148/radiol.2432050057pmid: 17384237
Gastroesophageal reflux disease (GERD) is a common medical problem in the United States. As a result, laparoscopic antireflux surgery is a common surgical procedure. At the authors' institution, the barium esophagram before and after antireflux surgery is a critical examination in patients with GERD. This article summarizes the authors' examination protocol and describes how the findings are integrated in the care of these patients.
doi: 10.1148/radiol.2432060307pmid: 17456865
The rapid progress of nanoscience and the application of nanotechnology are changing the foundations of diagnosis, treatment, and prevention of cardiovascular diseases. As the core of nanotechnology, nano- and microparticles offer “three-in-one” functions as imaging agents, target probes, and therapeutic carriers. While nano- and microparticle-based imaging of cardiovascular interventions is still in its developing phase, it has already presented the exciting potential to monitor primary interventional procedures for precise therapeutic delivery, enhance the effectiveness of delivered therapeutics, and monitor therapeutic efficiency after interventions performed to treat cardiovascular diseases. This article provides an overview of the current status of the application of nano- and microparticles in the imaging of cardiovascular interventions.
Poplack, Steven P.; Tosteson, Tor D.; Wells, Wendy A.; Pogue, Brian W.; Meaney, Paul M.; Hartov, Alexander; Kogel, Christine A.; Soho, Sandra K.; Gibson, Jennifer J.; Paulsen, Keith D.
doi: 10.1148/radiol.2432060286pmid:
Jiang, Yulei; Miglioretti, Diana L.; Metz, Charles E.; Schmidt, Robert A.
doi: 10.1148/radiol.2432060253pmid: 17456866
Purpose: To estimate the extent of variability in screening mammography cancer detection rates and its effect on a hypothetical clinical trial of a new screening modality used to measure changes in cancer detection rate. Materials and Methods: Each registry and the statistical coordinating center received institutional review board approval along with approval for consenting processes or a waiver of consent to enroll participants, link data, and perform analytic studies. This study was HIPAA compliant. The authors estimated the distribution of individual radiologists' breast cancer detection rates for 2 289 132 screening mammograms (9030 cancers) read by 510 radiologists in the United States who participated in the Breast Cancer Surveillance Consortium from 1996 through 2002. They then computed the distributions of breast cancer detection rates expected from a trial of screening mammography and multiple radiologists, as well as similar distributions for a hypothetical new modality that depicts one additional cancer per reader per 1000 screening examinations. Statistical power was calculated. Results: The mean screening mammography cancer detection rate for individual radiologists was 3.91 cancers (standard deviation, 1.93; range, 0.25–13.75) per 1000 examinations. To achieve 80% power to detect a hypothetical increase of one additional cancer detected per reader per 1000 screening examinations, a trial in which a new modality was compared with standard mammography would require at least 25 radiologists each reading the images of at least 8000 screening examinations or 91 radiologists each reading the images of 1000–2000 examinations. Conclusion: The low breast cancer prevalence in an average-risk screening population and the large interradiologist variability in the observed cancer detection rate suggest that for new technologies to demonstrate significant improvement in cancer detection rate in a clinical trial, very large samples of both radiologists and patients will be required.
Vrachliotis, Thomas G.; Bis, Kostaki G.; Haidary, Ahmad; Kosuri, Rajani; Balasubramaniam, Mamtha; Gallagher, Michael; Raff, Gilbert; Ross, Michael; O'Neil, Brian; O'Neill, William
doi: 10.1148/radiol.2432060447pmid:
Showing 1 to 10 of 42 Articles
Purpose: To prospectively assess quantitatively the inherent contrast of electromagnetic (EM) properties that can be imaged by using available technology in women with abnormal findings at conventional breast imaging who underwent subsequent biopsy. Materials and Methods: The protocol was HIPAA compliant and approved by the institutional review board. All participants provided informed consent. Fifty-three women with normal (Breast Imaging Reporting and Data System BI-RADS category 1) and ninety-seven women with abnormal (BI-RADS category 4 or 5) screening mammograms were imaged with three EM imaging methods: electrical impedance spectroscopy (EIS), microwave imaging spectroscopy (MIS), and near-infrared spectral tomography (NIR). A region-of-interest (ROI) analysis was used to assess the EM image properties for comparison of findings with conventional image findings and correlation with specific pathologic parameters for women with abnormal findings. Statistical analyses were conducted. Results: One hundred fifty participants (age range, 35–81 years) were included. EM image property contrast ratios of 150%–200% were found in breast abnormality ROIs relative to the ipsilateral breast background. Analysis of variance demonstrated significant differences in ROI image summaries of mammographically normal versus abnormal breasts for EIS, across diagnostic groups for NIR, and for MIS (analysis restricted to lesions larger than 1 cm 3 ). Receiver operating curve (ROC) analysis of the EM properties for cancers among subjects with BI-RADS category 4 or 5, compared with the EM properties for the subjects with normal breasts (BI-RADS category 1), yielded areas under the ROC curve ranging from 0.67 to 0.81. Pathologic correlations with mean vessel density, mean vessel area, and epithelium-to-stroma ratio suggest a biological origin of the EM image properties associated with disease. Conclusion: Results from EM breast examinations provide statistical evidence of a mean increase in image contrast of 150%–200% between abnormal (benign and malignant) and normal breast tissue.
Purpose: To prospectively evaluate the enhancement of coronary, pulmonary, and thoracic aortic vasculature by using biphasic single-acquisition 64-section computed tomographic (CT) angiography and to prospectively evaluate if differences in right side of the heart and coronary venous enhancement interfere with interpretation of coronary arteries. Materials and Methods: With internal review board approval and HIPAA compliance, 50 patients (16 men, 34 women; mean age, 51.5 years; range, 30–75 years) with atypical chest pain were referred from the emergency department and were imaged with a 64-section CT scanner after premedication with oral atenolol and/or intravenous metoprolol. Thoracic CT angiography with retrospective gating was subsequently performed with a single biphasic injection of 130 mL of iso-osmolar contrast material (100 mL at 5 mL/sec and 30 mL at 3 mL/sec) in caudal-to-cranial acquisition. Coronary, aortic, and pulmonary arterial attenuation values were obtained. Coronary venous and right atrial enhancement were evaluated to assess whether there was interference with coronary artery evaluation. A two-tailed Friedman test was used to evaluate differences among segments within each artery. Results: Mean coronary arterial, pulmonary arterial, and aortic attenuation values were significantly higher than the 250-HU threshold ( P < .05). Mean pooled coronary arterial (288.9 HU ± 64.8), pulmonary arterial (316.4 HU ± 79.9), and aortic (329.9 HU ± 63.3) attenuation values were significantly higher than the 250-HU threshold ( P < .0001). Coronary venous enhancement did not affect depiction or interpretation of coronary arteries. Right atrial streak artifact focally traversed the right coronary artery in only one study. Conclusion: The aforementioned thoracic CT angiographic protocol provides enhancement of coronary, aortic, and pulmonary vasculature in a single breath hold without interference from right side of the heart streak artifact or coronary venous enhancement.